Why do people in government refuse to listen when voters say no?
This year’s House Bill 24-1075 would require the Colorado School of Public Health to “research and deliver” model legislation for a single payer health care system. In single payer systems, government sets health care prices, determines treatments, and then decides who gets treated. Health care providers can go to jail for accepting any payment from any entity other than the state.
In 2016, almost 79 percent of Colorado voters rejected single payer care. They voted against Amendment 69, a single payer health plan for Colorado.
In response, the legislature created the Colorado Commission on Affordable Health Care.
When the Commission’s final report did not recommend a single payer plan in 2017, the legislature created a “Health Cost Analysis Task Force” in 2019, which in turn hired the Colorado School of Public Health to conduct a “financial analysis” comparing single payer health system costs with existing system costs. The economically illiterate conclusion was that single payer “pricing regulations” could control health care cost growth, and that Coloradans supported single payer. That conclusion rested on an analysis of personal interviews with fewer than 100 people and 550 responses to an online survey.
The School of Public Health is to deliver Colorado’s single payer plan, price controls and all, to the legislature by July 1, 2024. Given that delivery is required just a few months after the bill’s passage, the plan may already be drawn up and ready to go. As the bill allows the School to “accept, and expend gifts, grants, or donations from private or public sources for the purpose of conducting the analysis, it would be perfectly legal to use the School as a Trojan Horse for submitting a plan developed by a single payer advocacy group.
The bill states that only the Colorado School of Public health will analyze the costs and benefits of the proposed plan, thus limiting potential dissent. Twenty-one politically connected representatives and advocates from groups across “marginalized” and worker “communities” and “interests” will form an advisory board. The board is apparently for public relations purposes as it has no power. To further limit dissent, appointees can be voted off the board by a 2/3 vote. Just 6 of the 21 advisors represent those who produce health care.
The legislators should stop wasting time, energy, and tax money. A massive body of evidence shows that the voters got it right in 2016. Without prices to direct resource allocation, single payer systems misallocate resources, increase waste, and lower productivity. They deliver expensive, low quality health care.
Single payer systems control visible costs by skimping. They skimp on specialists, diagnostic imaging, new drugs, hospital care, surgery, imaging equipment, building upgrades, and nursing home beds. They ration care with slow adoption of new treatments and extensive waiting lists. Patients wait to see primary care practitioners, wait to see specialists, wait for labs and diagnostic imaging, and wait for treatment. They die on waiting lists, and suffer long periods of disability, costs that are not immediately visible and are rarely accounted for in superficial financial comparisons.
Incurable personnel shortages characterize single payer systems. Low capital investment reduces physician productivity. Burnout is common. People leave health care to work elsewhere due to the poor working conditions created by endless shortages of everything.
British Columbia’s single payer system is so mismanaged it pays for cancer patient radiation treatments in Bellingham, Washington. Its hip replacement wait can be almost a year, even though the government benchmark is 26 weeks. Government can make the treatment rules but who can make it obey them?
Because Canadian patients wait twice as long as recommended for MRI scans, those who can afford it pay cash for quick service at US imaging centers in border cities like Buffalo, NY and Bellevue, WA. They know that single payer universal health care access too often means universal access to a waiting list.
Given the evidence against single payer, why are the sponsors of House Bill 1075 so eager to push such a debacle onto the Colorado voters who have already overwhelmingly rejected it?
Linda Gorman is the director of health care policy at the Independence Institute, a free market think tank in Denver.
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